MEDA Membership Application Form

I am applying as an:

Active Member - $235
Associate Member - $235
Student Member - $25 (see requirements) - Must be paid at time of application. Either fill out the form below, print and send with a check, or submit the form online and call 517-241-0011 to pay using a Visa or MasterCard.

MEDA Membership is individual, not organizational.

Full Name:
  

Title:

Company/Organization:


Street Address:

City, State, Zip:

County:


Phone:

Fax:

 Email:


Company/Organization URL:
 

Brief description of economic development responsibilites:


How did you learn about MEDA?/ Who referred you? (Please name them.)


Percent of time spend on economic development: